I was recently made aware of a case that was published in the World Journal of Clinical Cases. This case study revolved around a patient who had neck pain with upper limb weakness and tingling/numbness. The patient in this case is similar to many who find their way into our practice sometimes at the outset of symptoms but other come to use after other care fails but before they try surgery. In this case the patient was recommended to have surgery and the surgeons decided on a 360 degree fusion which entails a plate with screws in the front of the spine and rods and screws in the back of the spine. Check out this picture to see what this looks like, it is rather nasty.
While it is fantastic that the doctors in this case were able to improve the symptoms of the patient and that improvement persisted for 6 months the long term effects might not be worth it. In our last post we discussed a paper that basically concludes that there will be further degeneration at levels adjacent to fused segments. While those authors did not see any significant increase in symptoms with that degeneration, in our practice we do see many patients years or even just months after fusion surgery who have new or continued spine pain. This paper is one of many that does indicate the spinal surgery community values improving the curves of the spine and the thus the patients posture as important outcomes. What is a bit troubling is that most of the surgical literature indicates they believe the only way to align the posture is through fusion surgery. I have linked this page in the past, but it is a great indicator of how spine surgeons at Columbia University’s medical center think fusion is the only way to improve the spinal curves. This is not true.
In our practice we have become rather good at correcting the cervical spine. In fact our methods have been examined by researchers and you can find several published studies on them like this one published by two medical doctors, this paper was published by the chiropractors who have researched our approach, and this recent paper published again by two medical doctors. This last paper is the one I want to mention primarily because it is both recent, published Sept 13 2014, and applies directly to the cervical spine. These researches took a group of people with neck and arm pain and divided them into three treatment groups. The first group received traditional PT, the second received traditional PT plus “medical” traction, the third group received traditional PT plus traction to restore their neck curve. Medical traction is traction with the head in flexion or bend slightly forward, the aim of this modality is to stretch the spine, not correct posture or the neck curve. The third group had a significant improvement in the curve of their neck while the other groups had little to no change. At the one year follow-up only the third treatment group, who had their neck curve improved, maintained the improvement in symptoms while the other groups regressed to their pre-treament pain levels.
All this is important because fusion to align the neck is not the only way to improve the neck posture, there are effective ways that have been tested in the literature. Fusion, in fact, comes with the potential to have new problems in the future and is not the best approach in most cases. Conservative care is the best first approach to treat neck pain but not just any conservative care a specific type that includes care to restore the normal neck posture. There is strong evidence that shows when we restore neck posture our long term outcomes are far better than what short term pain-relief care can offer.
If you or someone you know is suffering with chronic neck pain, get them to a chiropractor that understands the importance of posture and the curves of the spine to the point that their outcomes include a plan to realign your posture towards normal. We do this as do many other chiropractors you can find by looking at the Chiropractic BioPhysics doctors directory. Chiropractic BioPhysics is the technique that has been lightyears ahead on the analysis of posture and procedures to correct it. CBP doctors have published over 150 papers on spine correction and that includes the paper published Sept 13 because Dr. Harrison, who is the lead CBP instructor, was a consultant on that paper. Those Egyptian doctors used CBP analysis and protocols in their care to restore neck posture in the third study group.